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Purpose: Earlier work showed that IVIM-NET orig, an unsupervised physics-informed deep neural network, was faster and more accurate than other state-of-the-art intravoxel-incoherent motion (IVIM) fitting approaches to diffusion-weighted imaging (DWI). This study presents a substantially improved version, IVIM-NET optim, and characterizes its superior performance in pancreatic cancer patients. Method: In simulations (signal-to-noise ratio [SNR] = 20), the accuracy, independence, and consistency of IVIM-NET were evaluated for combinations of hyperparameters (fit S0, constraints, network architecture, number of hidden layers, dropout, batch normalization, learning rate), by calculating the normalized root-mean-square error (NRMSE), Spearman’s ρ, and the coefficient of variation (CV NET), respectively. The best performing network, IVIM-NET optim was compared to least squares (LS) and a Bayesian approach at different SNRs. IVIM-NET optim’s performance was evaluated in an independent dataset of 23 patients with pancreatic ductal adenocarcinoma. Fourteen of the patients received no treatment between two repeated scan sessions and nine received chemoradiotherapy between the repeated sessions. Intersession within-subject standard deviations (wSD) and treatment-induced changes were assessed. Results: In simulations (SNR = 20), IVIM-NET optim outperformed IVIM-NET orig in accuracy (NRMSE(D) = 0.177 vs 0.196; NMRSE(f) = 0.220 vs 0.267; NMRSE(D*) = 0.386 vs 0.393), independence (ρ(D*, f) = 0.22 vs 0.74), and consistency (CV NET(D) = 0.013 vs 0.104; CV NET(f) = 0.020 vs 0.054; CV NET(D*) = 0.036 vs 0.110). IVIM-NET optim showed superior performance to the LS and Bayesian approaches at SNRs < 50. In vivo, IVIM-NET optim showed significantly less noisy parameter maps with lower wSD for D and f than the alternatives. In the treated cohort, IVIM-NET optim detected the most individual patients with significant parameter changes compared to day-to-day variations. Conclusion: IVIM-NET optim is recommended for accurate, informative, and consistent IVIM fitting to DWI data.

Purpose For clinical implementation, a chemical exchange saturation transfer (CEST) imaging sequence must be fast, with high signal-to-noise ratio (SNR), 3D coverage, and produce robust contrast. However, spectrally selective CEST contrast requires dense sampling of the Z-spectrum, which increases scan duration. This article proposes a compromise: using a 3D snapshot gradient echo (GRE) readout with optimized CEST presaturation, sampling, and postprocessing, highly resolved Z-spectroscopy at 3T is made possible with 3D coverage at almost no extra time cost. Methods A 3D snapshot CEST sequence was optimized for low-power CEST MRI at 3T. Pulsed saturation was optimized for saturation power and saturation duration. Spectral sampling and postprocessing (B0 correction, denoising) was optimized for spectrally selective Lorentzian CEST effect extraction. Reproducibility was demonstrated in 3 healthy volunteers and feasibility was shown in 1 tumor patient. Results Low-power saturation was achieved by a train of 80 pulses of duration tp = 20 ms (total saturation time tsat = 3.2 seconds at 50% duty cycle) with B1 = 0.6 μT at 54 irradiation frequency offsets. With the 3D snapshot CEST sequence, a 180 × 220 × 54 mm field of view was acquired in 7 seconds per offset. Spectrally selective CEST effects at +3.5 and -3.5 ppm were quantified using multi-Lorentzian fitting. Reproducibility was high with an intersubject coefficient of variation below 10% in CEST contrasts. Amide and nuclear overhauser effect CEST effects showed similar correlations in tumor and necrosis as show in previous ultra-high field work. Conclusion A sophisticated CEST tool ready for clinical application was developed and tested for feasibility.

Since our previous publication of organ dose for the pediatric CT cohort in the UK, there have been questions about the magnitude of uncertainty in our dose estimates. We therefore quantified shared and unshared uncertainties in empirical CT parameters extracted from 1073 CT films (1978–2008) from 36 hospitals in the study and propagated these uncertainties into organ doses using Monte Carlo random sampling and NCICT organ dose calculator. The average of 500 median brain and marrow doses for the full cohort was 35 (95% confidence interval: 30–40) mGy and 6 (5–7) mGy, respectively. We estimated that shared uncertainty contributed ~99% of coefficient of variation of median brain doses in brain scans compared to unshared uncertainty (1% contribution). We found that the previous brain doses were slightly underestimated for 1990 compared to the results in the current study due to the revised CTDI models based on CT films.

Paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) is challenging to quantitate. Transthoracic echocardiography (TTE) is the main tool used for the assessment of PVL but is modestly reproducible. We sought to develop a reproducible echocardiographic approach to assess PVL in the post-TAVI setting. Four observers independently analyzed eleven parameters of PVL severity in 50 pre-discharge TTE studies performed after TAVI. The parameters included color-Doppler parameters [jet circumferential extent (CE) and planimetered vena contracta area in the short-axis view and jet breadth and qualitative features in the long-axis views], continuous-wave Doppler parameters [jet velocity time integral (VTI) and pressure half time (PHT)], quantitative Doppler parameters (regurgitation volume and fraction and effective regurgitant orifice area), aortic diastolic flow reversal and valve stent eccentricity. Intraclass correlation coefficient (ICC) and coefficient of variation (CV) for numerical parameters and kappa coefficient (κ) for categorical parameters were calculated for inter- and intra-observer comparisons. Inter-observer ICC was highest and CV lowest for CE (0.88 and 0.36), jet origin breadth (0.82 and 0.39), jet qualitative features in long-axis views (0.87 and 0.26), jet VTI (0.87 and 0.04) and PHT (0.73 and 0.10). Similar results were found in intra-observer comparisons. A 2-step granular approach combining the most reproducible parameters was used to grade PVL by the four observers. Inter-observer agreement was achieved in 86 % of cases (κ = 0.79). Combining color Doppler and continuous wave Doppler parameters in a granular algorithm yields excellent reproducibility of PVL assessment by TTE. Electronic supplementary material The online version of this article (doi:10.1007/s10554-016-0947-4) contains supplementary material, which is available to authorized users.

A.P.-F. and J.M.A.: conception and design, statistical analysis, interpretation of data, writing paper. F.J.A.G. and F.M.A.: conducted experiments, analyzed and interpretation of data, feedback on the paper. J.M.G.: feedback on the paper. J.H.M., J.S., and F.B.O.: interpretation of data, feedback on the paper. All authors read and approved the final manuscript., Heart rate variability (HRV) is a valid and non-invasive indicator of cardiac autonomic nervous system functioning. Short-term HRV recordings (e.g., 10 min long) produce data that usually is manually processed. Researcher subjective decision-making on data processing could produce inter- or intraresearcher differences whose magnitude has not been previously quantified in three independent human cohorts. This study examines the inter- and intra-researcher reproducibility of HRV parameters (i.e., the influence of R–R interval selection by different researchers and by the same researcher in different moments on the quantification of HRV parameters, respectively) derived from short-term recordings in a cohort of children with overweight/obesity, young adults and middle-age adults. Participants were recruited from 3 different studies: 107 children (10.03 ± 1.13 years, 58% male), 132 young adults (22.22 ± 2.20 years, 33% males) and 73 middle-aged adults (53.62 ± 5.18 years, 48% males). HRV was measured using a Polar RS800CX heart rate monitor. The intraclass correlation coefficient (ICC) ranged from 0.703 to 0.989 and from 0.950 to 0.998 for inter-and intra-researcher reproducibility, respectively. Limits of agreement for HRV parameters were higher for the interresearcher processing compared with the intra-researcher processing. On average, the intraresearcher differences were 31%, 62%, and 80% smaller than the inter-researchers differences based on Coefficient of Variation in children, young and middle-aged adults, respectively. Our study provides the quantification of the inter-researcher and intra-researcher differences in three independent human cohorts, which could elicit some clinical relevant differences for HRV parameters. Based on our findings, we recommend the HRV data signal processing to be performed always by the same trained researcher and we postulate a development of algorithms for an automatic ECG selection., Spanish Ministry of Economy and Competitiveness DEP2013-47540 DEP2016-79512-R PTA 12264-I, Spanish Ministry of Education, Culture and Sport FPU 16/02760 FPU15/02645 FPU15/04059 FPU14/06837 FPU14/04172, Unit of Excellence on Exercise and Health (UCEES), EXERNET Research Network on Exercise and Health in Special Populations DEP2005-00046/ACTI, Unit of Excellence in Sport and Health (UCEES) - University of Granada, Junta de Andalucía, European Union (EU) SOMM17/6107/UGR

Objective : In this paper, we assess the feasibility of using two detectors in a slot-scanning digital radiography system to acquire images for measuring bone mineral density (BMD) of the middle phalanx of the middle finger using dual-energy X-ray absorptiometry (DXA). Methods : Simulations were used to evaluate the spectral separation of the low- and high-energy spectra and detective quantum efficiency was used for assessing image quality. Scan parameters were chosen to optimize spectral separation, image quality, and radiation dose. We introduce the measurement of volumetric BMD ( v BMD) using basis material decomposition. We assess the accuracy of our methods by comparing measurements taken using bone images against reference data derived from subsequent incineration of the bones. In vivo scans were conducted to evaluate the system precision (repeatability) and agreement with a clinical densitometer. Results : Average errors for bone mineral content (BMC), areal BMD ( a BMD), and v BMD were 4.85%, 5.49%, and 12.77%, respectively. Our system had good agreement with a clinical densitometer based on concordance correlation coefficient values of 0.92 and 0.98 for a BMD and BMC, respectively. Precision studies yielded coefficient of variation (CV) values of 1.35% for a BMD, 1.48% for BMC, and 1.80% for v BMD. The CV values of all measurements were within 2%, indicating that the methods have clinically acceptable precision. Conclusion : We conclude that our techniques yield bone measurements with high accuracy, clinically acceptable precision, and good agreement with a clinical densitometer. Significance : We have shown the clinical potential of phalangeal DXA measurements of a BMD and v BMD on a slot-scanning digital radiography system.

In this paper, we propose a novel statistical index for the early diagnosis of ventricular arrhythmia (VA) using the time delay phase-space reconstruction (PSR) technique, from the electrocardiogram (ECG) signal. Patients with two classes of fatal VA - with preceding ventricular premature beats (VPBs) and with no VPBs have been analysed using extensive simulations. Three subclasses of VA with VPBs viz. ventricular tachycardia (VT), ventricular fibrillation (VF) and VT followed by VF are analyzed using the proposed technique. Measures of descriptive statistics like mean ({\mu}), standard deviation ({\sigma}), coefficient of variation (CV = {\sigma}/{\mu}), skewness ({\gamma}) and kurtosis (\{beta}) in phase-space diagrams are studied for a sliding window of 10 beats of ECG signal using the box-counting technique. Subsequently, a hybrid prediction index which is composed of a weighted sum of CV and kurtosis has been proposed for predicting the impending arrhythmia before its actual occurrence. The early diagnosis involves crossing the upper bound of a hybrid index which is capable of predicting an impending arrhythmia 356 ECG beats, on average (with 192 beats standard deviation) before its onset when tested with 32 VA patients (both with and without VPBs). The early diagnosis result is also verified using a leave out cross-validation (LOOCV) scheme with 96.88% sensitivity, 100% specificity and 98.44% accuracy., Comment: 25 pages, 16 figures, 2 tables